Treatment of Seven Patients with Ulcerative Colitis Complicated by Non-Toxic Megacolon

Abstract

We analyzed the characteristics and clinical courses of 7 patients with ulcerative colitis complicated with non-toxic megacolon who underwent surgery in our department. All cases were total colitis, and the median age at the time of diagnosis of megacolon was 51 years. Treatment before diagnosis of megacolon was 5-ASA and an intensive intravenous regimen in 6 cases, while 1 case was untreated. After diagnosis, the intensive intravenous regimen was continued in 3 cases, infliximab was started in 3 cases, and an intensive intravenous regimen was started in the untreated case. The surgical indications were perforation in 2 cases and refractory in 4 cases. Postoperative histopathological findings revealed ulcers deeper than the muscular layer in all cases, and we found that one of the refractory cases had covered perforation after surgery. Postoperative complications were intraabdominal abscess in 3 cases, SSI in 1 case, ileus in 1 case, leakage in 1 case, pneumonia in 1 case, and myocardial infarction in 1 case. These findings show that even if a case with megacolon is asymptomatic, it is likely to be accompanied by ulcers deeper than the muscular layer. Therefore, there is a possibility of perforation such as toxic megacolon, and this is considered to be an indication for surgery.